One of the biggest health insurance companies in the Netherlands announced last month that it will stop covering the costs of medical cannabis. The announcement, which comes at a time of increasing use of medical cannabis in the country, has sparked sharp criticism among patients.

A spokesperson for the Zilveren Kruis insurance company has said reimbursement for medical cannabis “can no longer be justified because in recent scientific research the effects of medicinal cannabis have not been demonstrated.” The research the company refers to is a 2015 article in the Journal of the American Medical Association that concluded that “cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear.”

But the Dutch Bureau of Medicinal Cannabis (BMC), part of the country’s Ministry of Health, sees things differently. In a brochure for patients, the BMC notes that “Medicinal cannabis as yet plays no role in the healing of diseases, but it can reduce the symptoms of the diseases. Medical cannabis can also help reduce the dosages and side effects of other medications.”

The decision to drop coverage, which takes effect this year, comes as more and more patients begin treating their ailments with cannabis. The country is on pace to see an 80 percent rise in the number of cannabis prescriptions this year, according to The Dutch Pharmaceutical Weekly, with a total of roughly 45,000 transactions. That number doesn’t include those patients who buy cannabis at the country’s many at coffeeshops or who purchase cannabis oil over the internet.

Since whole-plant cannabis oil is only available at a single pharmacy in the country, an underground network of growers has sprung up to supplying patients, mostly elderly people. The country has also seen an increase in Suver Nuver medical social clubs. They’ve sprung up in three Dutch cities, and two more are set to open next month, including one in Amsterdam.

The decision by Zilveren Kruis to stop reimbursing the costs for medical cannabis leaves only two smaller insurance companies that still cover cannabis treatment. It strikes many as a strange development in light of the fact that The Netherlands and Canada were the first countries in modern history to legalize medical cannabis on a national level, back in 2003.

Dr. Arno Hazekamp, a leading Dutch cannabis researcher who helped set up Bedrocan, the only legal cannabis production facility in the country, explained the development in a recent interview with Vice. “When a new drug is introduced on the market, it’s extensively researched and tested,” he said. “These studies cost millions, and they are paid for by the manufacturer, who has an interest in approval of the new drug, so that it can be sold at a large profit. That’s how they quickly recover the research costs. But nobody owns cannabis, so nobody wants to pay for large-scale clinical studies with cannabis.”

There is, of course, lots of small-scale research being done. What’s lacking, Hazekamp said, is coordination and standardizatiom. “Different researchers use different types of cannabis, different ways of taking the medicine, and different dosages,” he said, “so you end up with a lot of different stories.” He compared these smaller studies to pieces of a puzzle—taken together, they support the many positive effects of medical cannabis.

“In Germany they said, ‘We don’t exactly know for which conditions cannabis is effective,’” Hazekamp continued, “but they chose to authorize patients to use a selection of cannabis products in the coming years. These products have to meet certain quality standards, and all the patients are registered.”

In effect, that creates a gigantic research group. “Put together, this will be a large clinical study to gain experience with medical cannabis,” he said. “Insurance companies must cover the costs, so they can learn what is needed to set things up well. That’s a very scientific approach, and much more honest and decent than what is now happening in the Netherlands.”

As with many other subjects, every EU country seems to handle medical cannabis differently. Most European countries allow some form of medical cannabis, but not one has a comprehensive system in place that addresses the diverse needs of various medical patients and therapeutic consumers. There’s still some way to go until cannabis is a standardized item for insurers and medical professionals.

Across the continent, however, some things are clearly moving in the right direction, as recent breakthroughs in Ireland and Germany demonstrate. In the Czech Republic, too, the nation’s drug regulator is negotiating with the leading health insurer on the topic of medical cannabis coverage. Even in France, one of prohibition’s last strongholds in Europe, there is talk of reform. It may only be a matter of time before the Netherlands stops moving backward and returns to its pioneering role in decriminalizing and normalizing cannabis.

It’s even possible insurers such as Zilveren Kruis would reconsider their position on covering medical cannabis costs if Dutch authorities allowed the distribution and sale of registered products that are safe, effective, and thoroughly tested. Such products enable precise dosage of defined amounts of active cannabinoids—exactly what medical professionals are looking for in Europe’s emerging medical cannabis systems.

Derrick Bergman is a Dutch journalist, photographer, and activist who has been covering cannabis culture since 1994. He is a founder and the current chairman of the VOC, the union for the abolition of cannabis prohibition. Since 2010, he's served as the coordinator of Cannabis Liberation Day, the biggest cannabis and hemp event in the Netherlands. He is a father to three sons and has been growing his own cannabis for more than two decades.

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